Question 1

Clinical manifestations of right-sided heart failure include

Accepted Answer

The common manifestations of right ventricular failure are the following: jugular venous distention, elevated central venous pressure, weakness, peripheral or sacral edema, hepatomegaly (enlarged liver), jaundice, and liver tenderness.Gastrointestinal symptoms include poor appetite, anorexia, nausea, and an uncomfortable feeling of fullness.

Question 2

The nurse should anticipate which of the following as the most common complication after an MI?

Accepted Answer

Many patients experience complications occurring either early or late in the postinfarction course.These complications may result from electrical dysfunction or from a cardiac contractility problem.Pumping complications can cause heart failure, pulmonary edema, and cardiogenic shock.The presence of a new murmur in a patient with an acute myocardial infarction warrants special attention because it may indicate rupture of the papillary muscle.The murmur can be indicative of severe damage and impending complications such as heart failure and pulmonary edema.

Question 3

One differentiating factor between stable angina and unstable angina is that stable angina

Accepted Answer

Pain control is achieved by rest and by sublingual nitroglycerin within 5 minutes.Stable angina is the result of fixed lesions (blockages)of more than 75% of the coronary artery lumen.Ischemia and chest pain occur when myocardial demand from exertion exceeds the fixed blood oxygen supply.

Question 4

A 66-year-old patient is admitted to the critical care unit with a diagnosis of acute inferior MI.A 12-lead electrocardiogram (ECG)is done to validate the area of infarction.Which finding on the ECG is most conclusive for infarction?

Accepted Answer

The changes in repolarization are seen by the presence of new Q waves.These new, pathologic Q waves are deeper and wider than tiny Q waves found on the normal 12-lead ECG.

Question 5

In the acute phase after STEMI, fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery.The initial heparin bolus is

Accepted Answer

In the acute phase after ST segment elevation myocardial infarction, heparin is administered in combination with fibrinolytic therapy to recanalize (open)the coronary artery.For patients who will receive fibrinolytic therapy, an initial heparin bolus of 60 units/kg (maximum, 5000 units)is given intravenously followed by a continuous heparin drip at 12 units/kg/hr (maximum 1000 units/hr)to maintain an activated partial thromboplastin time between 50 and 70 seconds (1.5-2.0 times control).

Question 6

Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after STEMI?

Accepted Answer

Sinus bradycardia (heart rate less than 60 beats/min)occurs in 30% to 40% of patients who sustain an acute myocardial infarction (MI).It is more prevalent with an inferior wall infarction in the first hour after ST segment elevation MI.Sinus tachycardia (heart rate more than 100 beats/min)most often occurs with an anterior wall MI.Premature atrial contractions (PACs)occur frequently in patients who sustain an acute MI.Atrial fibrillation is also common and may occur spontaneously or may be preceded by PACs.Premature ventricular contractions (PVCs)are seen in almost all patients within the first few hours after an MI.

Question 7

Which of the following assessment findings is most specific for acute onset of pulmonary edema?

Accepted Answer

Patients experiencing heart failure and pulmonary edema are extremely breathless and anxious and have a sensation of suffocation.They expectorate pink, frothy sputum and feel as if they are drowning.They may sit bolt upright, gasp for breath, or thrash about.The respiratory rate is elevated, and accessory muscles of ventilation are used, with nasal flaring and bulging neck muscles.Respirations are characterized by loud inspiratory and expiratory gurgling sounds.

Question 8

The most frequent dysrhythmia seen initially with sudden cardiac death is

Accepted Answer

When the onset of symptoms is rapid, the most likely mechanism of death is ventricular tachycardia, which degenerates into ventricular fibrillation.

Question 9

Patient teaching regarding valvular heart disease should include which of the following?

Accepted Answer

Education for the patient with acute or chronic heart failure secondary to valvular dysfunction includes 
(1)information related to diet, 
(2)fluid restrictions, 
(3)the actions and side effects of heart failure medications, 
(4)the need for prophylactic antibiotics before undergoing any invasive procedures such as dental work, and
 (5)when to call the health care provider to report a negative change in cardiac symptoms.

Question 10

Which of the following values, when elevated, places the patient at lowest risk for CAD?

Accepted Answer

All of the reasons are not completely understood, but one recognized physiologic effect is the ability of HDL to promote the efflux of cholesterol from cells.This process may minimize the accumulation of foam cells in the artery wall and thus decrease the risk of developing atherosclerosis.High HDL levels confer both anti-inflammatory and antioxidant benefits on the arterial wall.In contrast, a low HDL level is an independent risk factor for the development of CAD and other atherosclerotic conditions.

Question 11

Which of the following cholesterol values indicates a heightened risk for the development of CAD?

Accepted Answer

Low-density lipoprotein (LDL)cholesterol is usually described as the "bad cholesterol" because high levels are associated with an increased risk of acute coronary syndrome (ACS), stroke, and peripheral arterial disease (PAD).High LDL levels initiate the atherosclerotic process by infiltrating the vessel wall and binding to the matrix of cells beneath the endothelium.Total cholesterol levels below 200 are considered normal.High-density lipoprotein (HDL)cholesterol levels below 40 are at low risk of coronary artery disease.Triglyceride levels below 150 are considered normal.

Question 12

You are teaching a patient with endocarditis about his diagnosis.Which statement below is correct?

Accepted Answer

Treatment requires prolonged IV therapy with adequate doses of antimicrobial agents tailored to the specific infective endocarditis microbe and patient circumstances.Antibiotic treatment is prolonged, administered in high doses intravenously, and may involve combination therapy.Best outcomes are achieved if therapy is initiated before hemodynamic compromise

Question 13

Assessment of a patient with pericarditis may reveal which of the following signs and symptoms?

Accepted Answer

Pain is the most common symptom of pericarditis, and a pericardial friction rub is the most common initial sign.A friction rub is best auscultated with a stethoscope at the sternal border and is described as a grating, scraping, or leathery scratching.Pericarditis frequently produces a pericardial effusion.

Question 14

One of the reasons that contributes to higher mortality rates from acute MI in women is:

Accepted Answer

Risk factors associated with acute myocardial infarction (MI)more strongly in women than in men include hypertension, diabetes mellitus, alcohol intake, and physical inactivity.Many reasons contribute to higher mortality rates from acute MI in women, and these include waiting longer to seek medical care, having smaller coronary arteries, being older when symptoms occur, and experiencing very different symptoms from those of men of the same age.

Question 15

A 66-year-old patient is admitted to the critical care unit with a diagnosis of acute inferior MI.A 12-lead electrocardiogram (ECG)is done to validate the area of infarction.For the above patient, which leads on the ECG would correlate with an inferior wall MI?

Accepted Answer

Inferior infarctions are manifested by electrocardiographic (ECG)changes in leads II, III, and aVF.Lateral wall infarctions are manifested by ECG changes in leads V₅ to V₆, I, and aVL.Anterior wall infarctions are manifested by ECG changes in leads V₂ to V₄.Posterior wall infarctions are manifested by ECG changes in leads V₁ to V₂.

Question 16

Medical management of hypertrophic cardiomyopathy includes

Accepted Answer

Pharmacologic management includes beta-blockers to decrease left ventricular workload, medications to control and prevent atrial and ventricular dysrhythmias, anticoagulation if atrial fibrillation or left ventricular thrombi are present, and finally drugs to manage heart failure.

Question 17

Nursing management of the patient with angina is directed toward

Accepted Answer

Nursing interventions focus on early identification of myocardial ischemia, control of chest pain, recognition of complications, maintenance of a calm environment, and patient and family education.It is important to document the characteristics of the pain and the patient's heart rate and rhythm, blood pressure, respirations, temperature, skin color, peripheral pulses, urine output, mentation, and overall tissue perfusion.

Question 18

An essential aspect of teaching that may prevent recurrence of heart failure is

Accepted Answer

Primary topics of education include (1)the importance of a daily weight, (2)fluid restrictions, and (3)written information about the multiple medications used to control the symptoms of heart failure.Reduction or cessation of diuretics usually results in sodium and water retention, which may precipitate heart failure.

Question 19

A patient with diagnosis of CAD with chest pain is admitted into the critical care unit.The patient is suddenly awakened with severe chest pain.Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief.A 12-lead ECG reveals nonspecific ST segment elevation.This patient probably has

Accepted Answer

Unstable angina usually is more intense than stable angina, may awaken the person from sleep, or may necessitate more than nitrates for pain relief.A change in the level or frequency of symptoms requires immediate medical evaluation.Severe angina that persists for more than 5 minutes, worsens in intensity, and is not relieved by one nitroglycerin tablet is a medical emergency.Stable angina is predictable and caused by similar precipitating factors each time; typically, it is exercise induced.Patients become used to the pattern of this type of angina and may describe it as "my usual chest pain." Pain control should be achieved within 5 minutes of rest and by taking sublingual nitroglycerin.Silent ischemia describes a situation in which objective evidence of ischemia is observed on an electrocardiographic monitor but the person does not complain of anginal symptoms.Variant unstable angina, or Prinzmetal angina, is caused by a dynamic obstruction from intense vasoconstriction of a coronary artery.Spasm can occur with or without atherosclerotic lesions.Variant angina commonly occurs when the individual is at rest, and it is often cyclic, occurring at the same time every day.

Question 20

Data concerning coronary artery disease (CAD)and specific risk factors have demonstrated

Accepted Answer

Research and epidemiologic data collected during the past 50 years have demonstrated a strong association between specific risk factors and the development of CAD.In general, CAD symptoms are seen in persons age 45 years and older.Primary cardiovascular risk factors are different in men and women, with women having higher rates of diabetes and hypertension compared with men.

Quiz 12: Cardiovascular Disorders